Kok, T.Y. (Thomas Ype) (2015) Triage bij psychische klachten in de huisartsenpraktijk : Onderzoek naar het gebruik van een beslismodel voor het gericht verwijzen van patiënten met psychische problematiek. thesis, Medicine.
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Abstract
Background: Since 2014, general practitioners (GPs) in The Netherlands can refer patients to mental health care only if the patient has a disorder that meets the DSM classification. Consequently a selection has to be made, to determine whether a patient will be treated within general practice or if the patient gets a referral. To assist the General practitioner in this selection process a decision-model has been developed that combines outcomes of the Four-Dimensional Symptom Questionnaire (4DSQ) with criteria developed to distinguish between generalist basic mental health care and specialized mental health care (HHM-criteria). The aim of this study was to determine whether this decision-model is suitable for targeted referral of patients with mental problems. Method: 408 patients with probable mental problems attending in 2014 a large general practice completed the 4DSQ at baseline and after three months in order to assess the effect of the treatment. The GP completed the HHM-criteria at baseline. The first 4DSQ combined with the HHM-criteria resulted in an indication for a treatment setting. This indication was compared to the actual place where the patient had been treated. In that way it could be decided if patients were treated following the outcome of triage or on a lower or higher level than indicated. Results: After three months 4DSQ-scores decreased in every treatment setting on each dimension. After controlling for baseline scores, there was no difference in decrease between treatment settings. Patients who received less intensive care than necessary booked comparable progress on the various dimensions of the 4DSQ than patients who were treated according to triage criteria. These results were maintained over alternative interpretations of the 4DSQ. Practice implications: This study showed that patients treated by GPs and practice mental healthcare workers had a similar reduction in symptoms as patients treated in the generalist basic mental health care and specialized mental health care setting, even patients with severe problems. However, this study was no experimental trial, but a naturalistic study. GPs could keep patients in general practice not requiring further intervention according to his clinical judgment. If follow-up studies demonstrate comparable results, general practice mental healthcare workers will be a good addition to the secondary mental health care. Conclusion: A randomized trial is required to give a thorough answer to the question whether the 4DSQ is a great addition to the already deployed HHM criteria.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | facultair begeleider: and Verhaak, prof. P.F.M. and Vakgroep huisartsengeneeskunde ─ onderzoekslijn Geestelijke and Groningen. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2708 |
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